Tuesday, May 27, 2008

Sen. Ted Kennedy is always said to be 'fighting' his cancer. In the New York Times, for example, Bob Herbert implores him to 'hang in there' and uses the words 'fought' and 'struggled' about his own father's response to cancer. The idea of fighting cancer - or any other disease - is now a standard media trope; it is even used about newly born babies. It is a word that fills a rhetorical gap. Reporting simply that somebody 'has' or 'is suffering from' cancer would seem to fall short of what the news requires. Worse, I imagine, would be 'has calmly accepted his fate' or 'placed himself in the hands of his doctors'. Worst of all would be 'is raging bitterly against his disease'. Personally, I have never seen anybody in any meaningful sense 'fight' a serious disease. I have seen people behave with greater or lesser equanimity, but never fight. How, after all, would one do it? Possibly the idea of fighting a disease is sustained by the evidence - ambiguous but persuasive - that one's state of mind can occasionally affect the course of a disease or it is simply a product of the fact that, nowadays, one can, indeed, spend one's last months in a desperate rush through the supermarket of possible cures. Either way, people have arrived at the notion that one can deploy mental strength as a weapon and that this is a virtuous thing to do. This supersedes a previous virtue - that of dignity and serenity in the face of death. Mental strength is, in this case, not a weapon but a consolation. A moment's thought will reveal the superior response. It is better to die consoled than defeated.

19 comments:

Surely it's all part of our old and superstitious tendency to demonize serious illness and see it as something exterior to ourselves, especially when it is poorly understood. Feeling punchy raises the spirits and may well help to raise the immune system - depression is known to lower it. And some punchiness is necessary, to get the best treatment (especially in the NHS lottery), to discourage people from treating one like a drooling invalid and to push on with daily life through pain and simple laziness. Lump it all together as a survival instinct if you wish, but our response to serious illness is not quite as clear-cut as may appear. Accepting one's ultimate fate doesn't mean lying down and saying "Steamroller me now, please".

There are many instances of a wife or husband dying, having been together for many years, followed very quickly by the partner, giving up the will to live ?, it may exist, this will to live. Placebos are thought to work, why ?

Methinks there is also an attitude that is both combative and serene - as in the Battle of Maldon or the Finnish Winter War, one knows one has no chance but fights anyway, for the sake of it. It's not a blind, stupefied rage, it's more a matter of not giving an inch.

In cinema we see this in Predator where Billy (the huge Native American) stops fleeing the predator and stands on the log bridge, waiting for it to come. He goes out fighting but also is serene, knowing he has no chance at all.

There does seem to be false dichotomy involved in the belief that not fighting is giving in Surrendering. Being steamrollered, etc.. No, far better to accept. Accept that death is natural. That it comes, we know not when, but as a thief in the night. To serenely accept and understand one's fate and deal with it accordingly is a more dignified way to depart this life than raging and fighting.

I disagree, but then I was diagnosed with an invariably fatal disease that, by all accounts, should have terminated my presence on earth almost 20 years ago. I don't pretend that I've struggled or fought against the disease, but I didn't sit around assuming a passive position of "dignity and serenity in the face of death." What you or others think of my subsequent behavior is of no great interest to me, there is no more "virtue" attached to it than there is to your supposed "previous virtue." At the same time, over the years, I have personally witnessed many others in the same situation and me whose responses could be aptly described as "raging bitterly against his disease," and "calmly accepted his fate." Whether one or the other was virtuous in their response is not for me to say.

As to whether it "is better to die consoled than defeated," I do not believe that the former precludes the latter nor does the latter exclude the former.

And Malty, a short novel I bet you'd love, Peter Pouncey's "Rules for Old Men Waiting." Man's wife has died, he intends to soon follow, but first he's going to write a little novel set in the WW I trenches, drink some good booze, and listen to some great music. Oh, yeah -- and he's snowed into his Cape Cod house. He's a Scot, btw, and formative years were spent in the Highlands -- great scenes of cornering eagles in their nests, rowing on the lochs.

Susan, I will read the book, sounds typically porridge scofferish, that character, Teddy boy was out on his yacht today, perhaps looking for his Chappequidic. The comments suprise me somewhat, living in the UK (and unless you can afford private medicine,) we are at the mercy of the NHS wallies, would you trust the doctors diagnosis enough to accept it and pack in ? I bet you wouldn't.

Malty wrote: "we are at the mercy of the NHS wallies, would you trust the doctors diagnosis enough to accept it and pack in ? I bet you wouldn't."

The NHS as an entity may be chaotic (largely thanks to political interference) but there are still plenty of outstanding men and women who work in it. If it wasn't for them, I'd be in a wheelchair by now thanks to one of those ailments that has "Hope you're better - for now. Love, your old pal Grim Reaper" stamped on it. Writing off the NHS is easy. Reforming it is devilishly hard but it's the only realistic option there is.

Anyway, to get back to Bryan's original point. Accepting that fate has kicked you in the goolies just means that fate has the final word in what happens to all of us. But so what. That doesn't mean I have to lie down right away and supinely declare it's all over.

Really? He is "always" said to be fighting? Are you saying that no matter where I look or for how long I will find nothing written about Ted Kennedy's cancer that does not say he is fighting it? Or were you using a bit of hyperbole, perhaps? Such as what people may be saying when they talk about "fighting" cancer, for example.

But in Ted Kennedy's case I think it fits. He didn't stay in his hospital bed and wait to die. He jumped out of bed against doctors orders and went home. The next day he went sailing. Perhaps he is simply in denial, but he does seem quite serene even though he refuses to let the cancer take over his life.

My wife was an RN on an oncology floor. She saw many patients fight their disease. Perhaps when you write that you "have never seen anybody in any meaningful sense 'fight' a serious disease," the lack is in you and not those who had the disease.

One way or the other, facing death is the ultimate challenge. How one approaches it is a matter of character. For some, this may amount to a 'fight'; to others, a lost cause. Either way, it is surely the worst of times. I wept recently while listening to Nuala O'Faolain, an Irish journalist and writer, when she spoke on radio of her utter despair and devastation upon discovering she had not long to live. She didn't feel strong. She didn't feel like 'fighting'. She just felt immense sorrow and torment at having to leave this world. But while she didn't want to go, she hadn't got the heart to go down the long treatment route with only a small glimmer of hope at the end of it. The cancer broke her heart. And so be it. That was Nuala's experience of death. It may not be like that for others.

I read that last interview with Nuala and was filled with regret. I had a chance to meet her -- I reviewed her book, "Chicago May," a couple years back -- when she came to Phila. on the book tour. In fact, she asked for me in the audience (a colleague was there who told her he knew me, but I was at work). Indeed, that is where I was. Instead of going to hear her speak at the Union League, I took an extra editing shift at the paper. I figured I'd be bound to run into her again sooner or later. Now I will never meet her, 'cause time for her has stopped just like Quentin Compson's watch in "The Sound and the Fury." No, that's a bad comparison -- he killed himself. She did not go gently into that great good night. She traveled, she enjoyed everyone she loved as long as she could.

Maybe that's the great lesson of death: Do what you can, what you mean to do, before it's too late.

Remarkable. My first visit to your blog, and here you have so succinctly described exactly my feelings about this matter while I was receiving treatment for breast cancer four years ago. I never felt like I was "fighting" it. I certainly cooperated with my doctors and fervently hoped and prayed for the best, but my inner response to the experience was much more that of submission, of wanting to lie down and let the doctors do their work to heal me. And the pink-ribbon breast cancer activists don't use that language much, do they? But the tropes of "fighting," "struggling," and "beating this cancer" simply didn't ring true or make sense for me. If they work for others, that's fine.

I also began to notice how nearly every obituary of a cancer victim valorized the deceased's "brave battle with cancer." Like you, I wondered, what's wrong with something like: "When treatments could offer no further hope, she submitted calmly, with grace, to her death"? If cancer comes back and kills me, I don't want the quasi-military cliches used in my obit.

Finally, I think I see in some of the comments here the assumption that such submission or acceptance is the same as giving up. I don't see that in Bryan's post. You can have that inner solemnity, a feeling of being called to quiet submission to the ordeal before you, and still work very hard at doing everything you can to get well.

A blog about, among other things, imaginary ideas - What ifs? and Imagine thats. What if photographs looked nothing like what we see with our eyes? Imagine that the Berlin Wall had never come down. What if we were the punchline of an interminable joke? All contributions welcome.